Local 827 v. Verizon NJ Inc

USDC for the District of New Jerse

Strömedel till mjölkkor

Strömedel används för att skapa en liggyta med god hygien och bra komfort för mjölkkor. Hygienen är betydelsefull för kostsamma sjukdomar som mastit och komforten påverkar hur länge korna väljer att ligga ned. Reducerad liggtid kan leda till stress, hältor och till viss del minskat foderintag. Ett lämpligt strömedel för mjölkkor bör vara mjukt, rent, torrt och strös i rikliga mängder. Det oorganiska strömedlet sand är positivt då det generellt har ett lägre bakterieinnehåll än organiska strömedel men verkar dock kräva en viss invänjningsperiod innan korna accepterar det som liggunderlag. Bättre accepteras strömedel som spån och halm. Strömedel som kan tänkas bli mer aktuella i framtiden är bland annat fiberströ, compost bedded pack, hästgödsel och komposterat hushållsavfall. Alla material har sina för- och nackdelar och vilket strömaterial som är bäst för den enskilde lantbrukaren beror på flera faktorer, bland annat utformning av stall, utgödslingssystem och strömetod.Bedding materials are used to provide a lying area with good hygiene and great comfort for dairy cows. Hygiene is important for diseases such as mastitis and comfort affect how long the cows choose to lie down. Reduced lying time can lead to stress, lameness and partially reduced feed intake. A lying area should be supplied with large amounts of bedding material that provides softness, cleanness and dryness. The inorganic bedding material sand is positive as it generally has a lower bacterial content than organic litter, but seems to require a certain introduction period before the cows accept it as lying surface. Better accepted bedding materials are sawdust and straw. Bedding materials that may become more relevant in the future are manure solids bedding, compost bedded pack, horse manure and box compost. All materials have their pros and cons and what litter is best for the individual farmer depends on several factors, including the design of stable, manure handling system and bedding method

Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England : a multi-centre cohort study of patients undergoing invasive care

OBJECTIVES: Older adults have a higher degree of multimorbidity, which may adversely affect longer term outcomes from non-ST elevation acute coronary syndrome (NSTE-ACS). We investigated the impact of multimorbidity on cardiovascular outcomes 5 years after invasive management of NSTE-ACS. DESIGN: Prospective cohort study. SETTING: Multicentre study conducted in the north of England. PARTICIPANTS: 298 patients aged ≥75 years with NSTE-ACS and referred for coronary angiography, with 264 (88.0%) completing 5-year follow-up. MAIN OUTCOME MEASURES: Multimorbidity was evaluated at baseline with the Charlson comorbidity index (CCI). The primary composite outcome was all-cause mortality, myocardial infarction, stroke, urgent repeat revascularisation or significant bleeding. RESULTS: Mean age was 80.9 (±6.1) years. The cohort median CCI score was 5 (IQR 4-7). The primary composite outcome occurred in 48.1% at 5 years, at which time 31.0% of the cohort had died. Compared with those with few comorbidities (CCI score 3-5), a higher CCI score (≥6) was positively associated with the primary composite outcome (adjusted HR (aHR) 1.64 (95% CI 1.14 to 2.35), p=0.008 adjusted for age and sex), driven by an increased risk of death (aHR 2.20 (1.38 to 3.49), p=0.001). For each additional CCI comorbidity, on average, there was a 20% increased risk of the primary composite endpoint at 5 years (aHR 1.20 (1.09 to 1.33), p<0.001). CONCLUSIONS: In older adults with NSTE-ACS referred for coronary angiography, the presence of multimorbidity is associated with an increased risk of long-term adverse cardiovascular events, driven by a higher risk of all-cause mortality. TRIAL REGISTRATION NUMBER: NCT01933581; ClinicalTrials.gov

Sex differences in long-term outcomes in older adults undergoing invasive treatment for non-ST elevation acute coronary syndrome : An ICON-1 sub-study

Background: Cardiovascular disease is the leading cause of mortality for females globally, yet females are underrepresented in studies of acute coronary syndrome (ACS). Studies investigating sex-related differences in clinical outcomes of patients with non-ST elevation ACS (NSTEACS) have reported divergent results, and it is unknown whether long-term outcomes for older people with NSTEACS differ between males and females. Methods: The multi-centre prospective cohort study, ICON-1, consisted of patients aged ≥75 years undergoing coronary angiography following NSTEACS. The primary composite endpoint was all-cause mortality, myocardial infarction, unplanned revascularisation, stroke, and bleeding. We report outcomes at five-years by sex. Results: Of 264 patients, 102 (38.6%) females and 162 (61.4%) males completed the five-year follow-up and were included in the analytic cohort. At admission, females were older than males (82 ± 4.3 years vs 80.0 ± 4.1 years p = 0.018). Co-morbidity profile and GRACE score were similar between the groups. There were no differences in the provision of invasive or pharmacological treatments between sexes. At five-years, there were no association between sex and the primary outcome. Conclusion: In older adults with invasive treatment of NSTEACS, provision of guideline-indicated care and long-term clinical outcomes were similar between males and females

Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management

Aim: Frailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown. Methods and results: The multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P  = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P  = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23-4.02, P  = 0.008; Fried: HR 1.81, 95% CI 1.00-3.27, P  = 0.048]. Conclusion: In older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years. Registration: Clinicaltrials.gov NCT01933581

Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

Globally, ischaemic heart disease is the leading cause of death, with a higher mortality burden amongst older adults. Although advancing age is associated with a higher risk of adverse outcomes following acute coronary syndrome (ACS), older patients are less likely to receive evidence-based medications and coronary angiography. Guideline recommendations for managing ACS are often based on studies that exclude older patients, and more contemporary trials have been underpowered and produced inconsistent findings. There is also limited evidence for how frailty and comorbidity should influence management decisions. This review focuses on the current evidence base for the medical and percutaneous management of ACS in older patients and highlights the distinct need to enrol older patients with ACS into well-powered, large-scale randomized trials

Promotion of ICT in schools A comparative study of national strategies to promote ICT in education at elementary and secondary levels in Japan and Sweden

Technological advancements in information and communication technologies (ICT) have resulted in a need to use ICT in schools. Sweden has actively promoted ICT in schools since the early 1980's. In Japan, 1994 saw the government's first step towards active promotion of ICT in education. In this study, we have compared the strategies used to promote the use of ICT in elementary and secondary schools in Sweden and Japan. Our findings suggest that a similar 3-step approach was used in both countries: 1, infrastructure; 2, effective use of ICT; 3, implementation of ICT. A significant difference was found in the way the two countries planned their strategies. Whereas Sweden focussed exclusively on ICT in schools, Japanese promotion of ICT in schools was part of a national ICT strategy to raise the ICT standard of the Japanese society. We suggest that this use of a national ICT strategy makes it possible for Japan to present a more cohesive approach to ICT promotion in schools

International Law and the Rescue of Refugees at Sea

International law provides a duty to rescue everyone in distress at sea. Rescue at sea often entails recovering survivors and bringing them on board ships or other rescue units. While their subsequent delivery and disembarkation may not always be controversial, they frequently are if those assisted are refugees and migrants. Coastal states are especially likely to be reluctant to accept disembarkation within their territories if the distress situation and rescue operation occurred in the course of attempts to enter the coastal state in a clandestine or otherwise irregular way. The controversial but unavoidable question in such situations is where refugees and migrants rescued at sea shall be brought for disembarkation. Until recently, international law was strikingly silent in this regard. However, following amendments to the two main treaties on maritime search and rescue — the International Convention for the Safety of Life at Sea and the International Convention on Maritime Search and Rescue — international maritime rescue law now requires that everyone rescued at sea be delivered to a ‘place of safety’. The responsibility to provide such a place or to ensure that it is provided lies with the state party responsible for the search and rescue region in which the survivors were recovered. However, ‘place of safety’ is not defined in these or any other treaty. Instead, the application is guided by a set of guidelines from the International Maritime Organization (IMO). However, the guidelines are not legally binding and many questions remain unanswered. This thesis examines the meaning of the concept of ‘place of safety’ against the background that many of those rescued at sea are refugees and migrants. Using a legal perspective, it asks how the meaning of this concept can be understood in the wider context of international law. The emphasis on the legal context links to the applicable standard of interpretation, which requires the meaning to be determined with reference to not only the text but also the context and the object and purpose of the treaty. Drawing on an explorative survey of the international legal framework for irregular maritime migration covering norms under the international law of the sea, international refugee law, international human rights law and international law against transnational organised crime and on a dedicated discussion of the applicable standard of interpretation, this thesis analyses the interpretation of the concept of ‘place of safety’. In keeping with the general legal framework of the interpretation of treaties, it explains that this concept cannot be understood with reference to the law of the sea exclusively, as it imports norms from other areas of international law. Due to the contribution of these other norms, including some of a primarily humanitarian character such as those dealing with non-refoulement, right to life and non-discrimination, this thesis argues that the meaning of the concept is broader than it first may seem. To conclude, this thesis summarises a ‘place of safety’ as a location where not only the maritime safety but also the basic security of survivors is no longer threatened

Voluntary cow traffic in AMR

A common automatic milking system (AMS) is the single box AMS, designed for 60 to 70 cows per unit (Bach & Cabrera, 2017), but there is also the automatic milking rotary (AMR; DeLaval Automatic Milking Rotary – AMRTM, Tumba, Sverige) with 24 bails and a higher capacity (Kolbach et al., 2013; Jacobs & Siegford, 2012a). Feed allowance in AMR can lead to advantages and affects cow traffic, both in the barn and in relation to the AMR (Scott et al., 2014; Kolbach et al., 2013). The aim of this study was to investigate the effect of giving teaser feed in AMR during voluntary cow traffic. The aim was also to investigate the effects of different length of adjustment periods in the experimental design. Furthermore, we hypothesized that primiparous cows would adapt faster to the system than multiparous cows and therefore spend less time than multiparous cows in the premilking area. We theorized that results after a longer adjustment period would have less variance and a more reliable outcome than results after a short adjustment period. To examine this, four treatments were implemented: No teaser feed – 1 week adjustment period, Teaser feed – 1 week adjustment period, Teaser feed – 3 weeks adjustment period and No teaser feed – 3 weeks adjustment period. The study was performed in 2018 at the Swedish Livestock Research Centre at Lövsta, Swedish University of Agricultural Sciences, Uppsala and 113 ± 10 cows were included and housed in an insulated naturally ventilated free-stall barn. A trough was installed at the first bail in the AMR to provide the cows with teaser feed (~ 50 g concentrate) when they entered the AMR. All experimental periods, i.e., when data was collected, had the length of one week and followed after every treatment. Data was collected with video recordings and the herd management software DelProTM (DeLaval International AB, Tumba, Sweden) and was used to analyse how fast the cows entered the AMR, how many cows were needed to be fetched by staff and how long time the cows spent in premilking areas. When analysing how fast the cows entered the AMR and how long time they spent in premilking areas, parity and lactation stage was taken into account. To include parity and lactation stage, ~ 30 focal cows were marked. Video observations from 821 entering’s and data from 72 milkings showed that teaser feed made the cows enter the AMR with faster speed and less cows were needed to be fetched by staff than without teaser feed, independent of adjustment period. Results from 464 observations showed that cows spent less time in premilking areas after one week with teaser feed compared to after three weeks without teaser feed. Primiparous cows entered the AMR with faster speed compared to multiparous cows but both primi- and multiparous cows spent the same amount of time in premilking areas, independent of treatment. In retrospect, results regarding adjustment period in this study are weak and should not be used in future research. However, length of adjustment period did not seem to influence the numerical variance but providing teaser feed led to a numerical decrease in variance in data. Overall, this study indicates that offering teaser feed in AMR can be beneficial and have a potential to improve cow traffic